PATHOLOGY. 
men are ferviceable. Tepid water thrown into the va¬ 
gina, conditutes a direft fomentation to the part aft’e£led. 
Mild laxatives, and, at bed-time, five grains of Dover’s 
powder, and three of camphor, may be reforted to with 
advantage. If drangury be confiderable in degree, a 
large dole of opium will be neceffary, fueh as 6o or 80 
drops of laudanum, and fmaller dofes frequently repeat¬ 
ed, afterwards, with mucilaginous drinks. Whenever the 
bladder is unequal to the expulfion of its contents, the 
catheter fhould be ufed ; for it will be in vain to trull to 
diuretics. Although it is not often neceffary to keep 
the patient in bed, yet the horizontal pofition fiiould be 
perfilled in for fome time, and all nevvcaufes of irritation 
(efpecially copulation) avoided. 
The next appearance to be noticed in vaginal difcharges 
is that of pus. This fluid is fometimes J'rcreted from the 
mucous membrane of the uterus and vagina in confe- 
quence of inflammatory atfion. It is diftingnilhed from 
the fluid which flows from an ulcer or abfcefs by this cir- 
cumllance ; that the pus poured from an ulcerated cavity 
in the uterus is frequently mixed with blood, while that 
fecreted from the unaltered membrane during the inflam¬ 
matory procefs is rarely difcoloured by the fanguineous 
fluid: it is in fa£l a muco-purulent difcharge. Now the 
fymptoms of this complaint are, generally fpeaking, not 
very different from thofe which attend the mucous dif¬ 
charge which inflammation induces in the parts in quef- 
tion. When the vagina is particularly affedled, itching 
of the external parts, and a fenfation of burning, exten¬ 
ded from the labia “ up the body” (as it is expreffed by 
patients), are experienced ; and, when the os uteri is 
open, little difference is found between this and common 
phlogofes of its lining, except perhaps that the pain in 
the laft is more violent. Add to this, that in all cafes 
of purulent difcharge, even when this is in fmall quan¬ 
tity, hedlic fever and weaknefs and emaciation are feldom 
abfent. 
It is to be remembered, however, that the drudlure of 
the vagina and of the uterus renders them liable to fome 
peculiar fymptoms from the difeafe in queftion. Thus 
the cellular fubftance of the vagina, being much furnifhed 
■with veffels,,and liable to many fources of irritation, is 
liable alfo to have abfceffes formed, when the mucous 
membrane has been fo much difeafed as to produce pus. 
Thefe abfceffes are of courfe only to be detedled by ma¬ 
nual examination ; and to be treated by the practice 
ufually followed in other abfceffes. It is fdrffc difcovered 
on the part of the patient by a fudden breaking of fome 
internal part, followed by a copious difcharge. 
When pus is fecreted in the womb, and the os uteri, 
from its clofure by means of coagulable lymph or from 
the firmnefs of its contradlion, denies an exit to this 
fluid, a peculiarfet of fymptoms arife. Theuterus fwells 
in a rapid manner; fo rapidly indeed, that it might be 
taken for pregnancy, if the tendernefs of the belly, the 
acute pain in the back, the general difeafe of the patient, 
and the occafional palling of menltrual mixed with puru¬ 
lent difcharge, did not forbid fuch a fuppofition. Some¬ 
times the os uteri opens in confequence of the didending 
form of the enclofed fluid ; but on fome occafions this has 
been here fo far from taking place, that the pus has only 
found exit by an ulcerated paffage through the ftridlure 
of the difeafed organ into the redtum. It is fcarcely ne¬ 
ceffary to add, that the ufual means of moderating vaf- 
cular adlion, foothing the nervous irritability of the part 
by fomentations, and of the fyftem by narcotics, and in¬ 
ducing an healthy Hate of blood by proper diet and me¬ 
dicine ; are required in this difeafe to be condudled in the 
fame manner as in abfcefs, or in inflammation of the 
mucous membranes. 
3. Leucorrhoea fenefcentium: thin, acrid, frequently 
excoriating and fetid. 
Under this term we (hall include thofe difeafes which, 
according to Mr. Clarke’s arrangement, are attended with 
a watery difcharge. In doing this, we fear we pay too 
•325 
little refpedl to the nofological arrangement of Dr. Good ; 
but the fadt is, that we find no evidence of this kind of 
difcharge as an idiopathic difeale ; and moreover, we do 
not find that all the difeafes of which it is a fymptom are 
fpecified in our fyftem. To leave them out on this ac¬ 
count would be unpardonable. 
1. A difcharge refembling clearwater, containing very 
little or no glutinous matter, refultsfrom cauliflower ex- 
crefcence of the os uteri, hydatids of the uterus, or 
oozing excrefcence of the labia. 
The cauliflower excrefcence is fo named from its ftri- 
king refemblance to the upper furface of a cauliflower, 
or a head of brocoli. The furface is granulated, and con- 
fifts of a great number of fmall projedtions, which may 
be picked off from the furface, as the granules may be de¬ 
tached from the vegetable. The firmnefs of the tumour 
agrees alfo with that of the plant: here the granules will 
be large and irregular, there fmall and equal. From a 
very fine membrane fpread over the furface of this tu¬ 
mour is poured out the aqueous fecretion. As the ru¬ 
mour occupies the upper part of the vagina, it is con¬ 
cealed from view ; but in fome cafes, where it attained 
a confiderable fize, Mr. Clarke harl feen it, and afferts 
that it had a bright flelh colour. It pours out arterial- 
lookingblood very plentifully, if injured during examina¬ 
tion, and fometimes fponraneoufly in plethoric habits. 
This excrefcence has little or no fenfibility ; can never be 
traced into the cavity of the uterus; is fometimes rapid 
in its growth, but much influenced by the contradlile 
power of the vagina, being more rapidly developed in 
married women who have borne children than in Angle 
women. It is highly vafcular, and is of a ftrudlure ana¬ 
logous to the placenth. 
A perception of moifture, and then gradually an incon¬ 
venient difcharge, are the firll fymptoms. The difcharge 
increafes; but, being unattended by pain or fcetor, the 
complaint is negledted, until a tinge of blood is per¬ 
ceived, or the colour of the cheek begins to change, 
with a correfponding lofs of ftrength. Then the alarm 
is taken. A difcharge of blood almoft always fucceeds 
fexual intercourfe; the digeftion begins to be impaired , 
hyfterical fymptoms are produced, and all that boll of in¬ 
explicable phenomena confequent on derangement of the 
chylopoietic vifcera, increafing the patient’s flock of bo¬ 
dily and mental mifery. Increafe of debility is accom¬ 
panied with decreafe of abforption, and, of courfe, with 
depolitions of fluid in different parts of the body, pro¬ 
ducing cedema of the feet at night, and puffinefs of the 
face and eyelids in the morning. On this account, hy¬ 
drothorax may deftroy the patient long before flie would 
have been exhausted by the difeafe itfelf. An alarming 
hatmorrhage fometimes induces a fatal fyncope. No 
great degree of emaciation, in general, attends the com¬ 
plaint. On the contrary, in feveral diffedlions, a layer 
of fat, of confiderable thicknefs, has been found cover¬ 
ing the abdominal iriufcles. This fat Ante of the fubjeft 
of fuch an excrefcence, forms a remarkable contrail to 
the extreme emaciation which attends carcinomatous tu¬ 
mours. The feel of this tumour by the finger diltin- 
guifhes it from the hardened cervix uteri of the incipient 
carcinoma, and from the irregularity of furface met with 
in the ulcerated flate of the fame organ. The difcharge 
alfo differs; yet, as in this complaint a difcharge is pre- 
fent, as now and then it is fcetid, as a tumour is found 
upon examination, and as the difeafe has always, fooner 
or later, a fatal tendency, it has been too frequently con¬ 
founded with carcinoma. The prognoftic, as to the ulti¬ 
mate event, it is true, mud be nearly the fame ; but there 
is reafon to believe that the fize of the tumour may be 
dimini/hed by judicious management, particularly by di- 
minilhing the adlion and fulnefs of the blood-veffels of 
the neighbouring parts. At all events, enlargement of 
the tumour will be greatly retarded. 
With this view, local blood-letting from the region of 
the facrum and hips is a mod valuable remedy. The 
quantity 
